Unilateral and bilateral bladder neck suspension (modified Pereyra) operation for stress urinary incontinence

Transvaginal correction of pelvic prolapse

Pelvic prolapse has a myriad of clinical manifestations ranging from urethral incontinence to total vault prolapse. The evaluation and treatment of these conditions is facilitated by dividing them into three anatomic regions. Anterior vaginal wall prolapse is the most common type and includes simple urethral hypermobility as well as severe cystocele. Surgical treatment includes the modified anterior vaginal wall sling, six-corner bladder neck suspension, and formal cystocele repair. Posterior vaginal wall prolapse, manifested by rectocele and perineal relaxation, is corrected by plication of the prerectal and pararectal fascia, reconstruction of the levator hiatus, and repair of the perineal body. Vault prolapse includes enterocele, uterine prolapse, and generalized vault prolapse. The choice of treatment depends on the presence of anterior vaginal wall prolapse, the degree of vault prolapse, and the patient's desire to remain sexually active. It is important to remember that urethral incontinence is only one manifestation of pelvic prolapse, and must be treated in conjunction with other prolapse to avoid recurrence or poor results.

Surgery for stress urinary incontinence

Stress urinary incontinence is a common problem, with various degrees of disability. Its etiology may be defective external or internal urethral sphincter mechanisms. Evaluation of the patient with symptoms of stress incontinence requires objective testing for diagnostic accuracy. Patient management may be individualized to conservative measures or to one of the various surgical approaches, which produce success rates between 80% and 95%. Retropubic suspension or long needle procedures should be considered for patients with stress incontinence and evidence of bladder neck detachment. Sling procedures, artificial sphincters, and periurethral injections should be considered for patients with minimal bladder neck mobility or low urethral pressures and for those with a high risk of failing other procedures.

Retropubic long-needle suspension procedures for stress urinary incontinence

A brief review of the Pereyra and the Stamey procedures and their modifications, including success rates and potential problems, is presented. A new modified technique is described that has potential advantages of ease, rapidity, less dissection, and less blood loss than may be seen with the modified Pereyra procedure and less chance of foreign body reaction than may be seen with the Stamey procedure. Twenty patients with significant stress urinary incontinence (14 with concurrent severe pelvic relaxation) underwent the procedure with an 80% cure plus 5% significant improvement rate noted 12 to 39 months after operation. All failures occurred in patients who were obese and involved apparent suture pull-through. Complications were minimal. Suggested causes for failures are discussed.

Endoscopic vesicourethropexy for stress urinary incontinence. Experience at the Medical Center Hospital of Vermont

Forty-eight women with stress urinary incontinence underwent endoscopic vesicourethropexy between December, 1978, and December, 1982, at the Medical Center Hospital of Vermont or its affiliates. Four patients were lost to follow-up within six weeks, and 44 patients were followed for four to forty-one months. The overall success rate was 79.2 per cent. Failures occurred as late as fourteen months. The major complication rate was 33.3 per cent. Major complications included suprapubic abscess formation and prolonged urinary retention for up to six months. Though an obviously effective therapy for the correction of stress urinary incontinence, our success with endoscopic vesicourethropexy is less than that generally reported. Further, the incidence and nature of postoperative complications in our series provoke a greater awareness of the potential shortcomings of this procedure.

Peripubic urethropexy for urinary stress incontinence in women

A technique for urinary stress incontinence is described that suspends the bladder neck and urethra by placing two vertical sutures along each posterior-lateral side of the entire urethra and tying them completely around the public bones. Six cases are reported and results given.

Suprapubic endoscopic vesical neck suspension

Experience with 20 endoscopic vesical neck suspensions (Stamey procedure) is compared to 20 matched anterior cystourethropexies (Marshall-Marchetti-Krantz procedure) performed by the same staff. The present procedure is a transvaginal vesical neck suspension, described in 1959 by Pereyra, modified in 1973 by Stamey and further modified in 1975 by Mason. The long-term success rate for relief of urinary stress incontinence was 90 per cent with either procedure. Advantages and disadvantages of the endoscopic vesical neck suspension are discussed.